Pain is personal — and so is the treatment of pain.
When it comes to chronic pain, over-the-counter drugs, prescription medications and many procedures can help. But when they don’t provide enough relief — or help at all — what else can you try?
There is a broad spectrum of medication-free approaches to address chronic pain, and using more than one type of treatment is often best, says W. Michael Hooten, M.D., a pain specialist, anesthesiologist and psychiatrist at Mayo Clinic and medical director of Mayo Clinic’s Pain Rehabilitation Center in Rochester.
“Whether it’s acupuncture, yoga or other movement therapies, chiropractic, or physical therapy, we try to find the best combination of treatments that will lead to long-term improvements in quality of life and functionality,” he says.
Ultimately, healthcare teams should consider treatments preferred by individual patients, as long as those treatments are safe and effective, Dr. Hooten says.
“An important part of my job is spending time listening to patients to help identify treatments they prefer, and to help set up reasonable and obtainable goals for treatment,” he says.
Complementary therapies
Here are some complementary therapies that have been studied in alleviating some types of chronic pain.
Acupuncture. This therapy involves inserting very thin needles at strategic points on the body, and it is commonly used to treat pain. The therapy comes from traditional Chinese medicine, and many acupuncture practitioners believe that acupuncture is a way to re-balance energy flow in the body. Others see the therapy as a way to stimulate nerves, tissues and muscles. Many people find it helpful as a way to control a variety of painful conditions, with research backing up its potential to help alleviate certain kinds of pain such as pain after surgery and back pain. Several studies, however, indicate that some types of simulated acupuncture appear to work just as well as real acupuncture.
Chiropractic care. This treatment focuses on the spine and involves a specialist manipulating the spine through pressure on certain spinal joints. Rare complications include a herniated disk, a stroke after a neck adjustment and compression of the spinal nerves. This treatment may have a modest benefit on low back pain, and possibly other kinds of pain such as neck pain and headaches. Some people do not respond to chiropractic adjustments.
Massage. There are many kinds of massage that aim to alleviate pain by moving and manipulating the muscles and soft tissue in the body. Massage may help mitigate certain kinds of pain like neck and shoulder pain, and possibly osteoarthritis knee pain.
Cognitive behavioral therapy (CBT). This is a common type of talk therapy, also known as psychotherapy. Cognitive behavioral therapy is one of the most effective methods to help people learn to reduce their chronic pain and improve functioning and quality of life.
Chronic pain can lead to thoughts like, “I’ll never be able to do what I want because my back hurts all the time.” It’s also typical to develop habits such as talking about pain, groaning, limping and limiting activity in response to chronic pain.
But these thoughts, emotions and behaviors can actually worsen pain. Changing those thoughts and behaviors also can change your perception and experience of pain.
“Cognitive behavioral therapy helps individuals recognize how maladaptive thoughts and behaviors about chronic pain affect their lives,” Dr. Hooten says. “This type of therapy helps most people regardless of the underlying chronic pain diagnosis.”
Advanced interventions for chronic pain
Treatments like massage and acupuncture aren’t your only options for chronic pain relief that don’t involve swallowing a pill.
Advanced interventions are another method of relieving and treating chronic pain. People often overlook these types of treatments, but they can be very effective depending on the pain diagnosis you have, Dr. Hooten says.
One approach targets the messages and signals your body sends about pain. You constantly receive information from all your senses, which your nerves and spinal cord send to your brain to be processed. Some of the messages your brain receives are signals about chronic pain. A variety of implanted devices can target back, neck and head pain by sending electrical pulses that can scramble or interrupt pain signals traveling to and from the brain.
Chronic low back pain is a good case to consider, Dr. Hooten says, where a spinal nerve root has been pinched or damaged irreversibly. An intervention called spinal cord stimulation can help with that. In this procedure, a small electrode is placed in the epidural space of the spinal canal and then a battery generator, similar to a little computer, is implanted under the skin. Then, the person can use a remote control or a cellphone to turn the stimulator on or off.
“This device directs an electrical field toward the spinal cord and helps ‘turn off’ or diminish the intensity of pain signals going through the spinal cord and eventually to the brain,” Dr. Hooten says. “This is a very advanced, specialized intervention.”
X-ray-guided injections, such as epidurals, offer another type of advanced intervention. Other types of injections are performed using ultrasound technology to guide a needle to target a specific nerve or other painful area of the body. X-ray-guided and ultrasound-guided injections are generally performed using a combination of steroids, local anesthetics and other medications, Dr. Hooten says.
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